JP2003033360A - Anastomotic appliance of tubular body - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an anastomotic appliance of tubular body which has simple structure and can anastomose a blood vessel by several clips easily and surely. SOLUTION: The anastomotic appliance of tubular body 1A of this invention comprises an appliance body 2 which has a pair of arms 21, 22, a gripping chuck 3 which is set up on the tip of the body 2, and an operating portion which is set up on the rear anchor of the body 2, and opens and shuts the arms 21, 22. A plurality of the clips 10 are retained between a retainer plate 31 and a retainer plate 32 of the gripping chuck 3. These clips 10 are arranged along a circular arc and correspond to approximately half round of a superposed portion pinched by the clips 10. When the arms 21, 22 are shut by operation, the retainer plates 31, 32 mutually approach, and pinch and deform the clips 10. Guide thread insertion splits 313, 323 formed to the retainer plates 31, 32 enable the insertion of a guide thread to tie the superposed portions tentatively and to introduce the superposed portions inside the clips 10.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a tubular body anastomosis instrument for joining an end portion of a tubular body and an everting portion of a blood vessel with a clip.

[0002]

2. Description of the Related Art Surgery for replacing a part of a living blood vessel with an artificial blood vessel, that is, transplantation operation of an artificial blood vessel is performed. In this operation, an artificial blood vessel is anastomosed to a living blood vessel.

[0003] In this anastomosis, suturing with a thread has been conventionally used, but in recent years, a method of sandwiching and joining a joint portion with a plurality of clips has been proposed. This anastomosis of blood vessels by clips is drawing attention because of the possibility that a procedure can be performed quickly, and an anastomosis instrument suitable for anastomoses of blood vessels by clips is desired.

[0004]

SUMMARY OF THE INVENTION An object of the present invention is to provide a tubular body anastomosis instrument having a simple structure and capable of easily and reliably performing an anastomosis of blood vessels by a plurality of clips.

[0005]

The above objects are achieved by the present invention described in (1) to (9) below.

(1) A plurality of clips are attached to the superposed portion where the end portion of the tubular body and the everted portion of the blood vessel are superposed, and the end portion of the tubular body and the everted portion of the blood vessel are joined. A tubular body anastomosis instrument for holding a plurality of the clips in a state of being arranged so as to correspond to substantially a half circumference of the entire overlapping portion, and an operation portion for performing an operation of deforming the plurality of clips. A transmission mechanism for transmitting an operation of the operation portion to the holding portion to clamp and deform the plurality of clips, and the superposing portion inside the plurality of clips held by the holding portion. A tubular body anastomosis instrument, characterized in that the tubular body anastomotic device is inserted, and the plurality of clips are deformed by the operation of the operation portion to sandwich and join the end portion of the tubular body and the everting portion of the blood vessel.

(2) The holding section holds the plurality of clips so as to be arranged along an arc.
The tubular body anastomosis instrument according to.

(3) The radius of curvature of the arc is 1 to 50 m
The tubular body anastomosis instrument according to the above (2), wherein m is m.

(4) The transmission mechanism has a pair of arm portions rotatably connected to each other in the middle or at the ends thereof, and the operation portion is provided on the base end side of the both arm portions and the tip end side. Holding portions are provided respectively, and by operating the operation portion so that the proximal ends of the both arm portions are closed, the distal end sides of the both arm portions are closed and the plurality of clips are deformed ( The tubular body anastomosis instrument according to any one of 1) to (3).

(5) The tubular body anastomosis instrument according to the above (4), which has arm restricting means for restricting the front ends of the both arms from opening beyond a certain limit.

(6) The tubular body anastomosis instrument according to any one of the above (1) to (5), which has a deformation amount regulating means for regulating the deformation amount of the clip.

(7) The tubular body anastomosis instrument according to any one of the above (1) to (6), which has guide thread insertion grooves formed at a plurality of locations near the holding portion and into which guide threads can be inserted.

(8) The tubular body anastomosis instrument according to any one of the above (1) to (7), wherein the clip is substantially C-shaped.

(9) The tubular body anastomosis instrument according to any one of the above (1) to (8), wherein the holding portion has a recess into which a part of the clip can be inserted.

[0015]

BEST MODE FOR CARRYING OUT THE INVENTION The tubular body anastomosis instrument of the present invention will be described below in detail with reference to the preferred embodiments shown in the accompanying drawings.

<First Embodiment> FIG. 1 is a perspective view showing a first embodiment of the tubular body anastomosis instrument of the present invention, and FIG. 2 is an enlarged view of the distal end portion of the tubular body anastomosis instrument shown in FIG. FIG. 3 is a perspective view of the tubular body anastomosis instrument shown in FIG. 1 (a state in which both arms are open), and FIG. 4 is a sectional view of a holding portion in the tubular body anastomosis instrument shown in FIG. FIG. 7 is a diagram for sequentially explaining the method of using the tubular body anastomosis instrument shown in FIG. 1, FIG. 8 is a sectional view of the anastomosis portion, and FIG. 9 is a perspective view of the anastomosis portion. In the following description, the diagonally right upper side in FIGS. 1 to 3 is referred to as a “base end”, and the diagonally lower left side in FIG. 1 to FIG. 3 is referred to as a “tip”.

A tubular body anastomosis instrument 1A shown in FIG. 1 has an elongated body portion 2, a holding portion 3 which is provided on the distal end side of the body portion 2 and holds a plurality of clips 10, and a proximal end side of the body portion 2. The operation unit 4 is provided.

The main body 2 includes a pair of elongated arms 21 and 22.
have. The arm portion 21 and the arm portion 22 intersect at an intersecting portion 23 in the middle (near the tip end portion) thereof, and at the intersecting portion 23, a pin 24 is rotatably coupled to each other.

As shown in FIG. 3, between the arm portion 21 and the arm portion 22 on the base end side of the intersection portion 23, the arm portions 21, 2 are provided.
A spring (torsion spring) 25 is installed as an urging unit that urges the device 2 to open.

The spring 25 can be inserted into the long holes 211 and 221 formed in the arms 21 and 22, respectively. When the arms 21 and 22 are closed, the spring 25 is inserted into the long holes 211 and 221 as shown in FIG. 1 to close the arms 21 and 22 until the arms 21 and 22 come close to each other. You can

A hook (arm restricting means) 26 capable of engaging with the arm 21 is provided near the base end of the arm 22.
When the arm portion 21 is engaged with the hook 26, the arm portion 21,
22 is regulated so as not to open beyond a certain limit. That is, in the state shown in FIG. 1, the arms 21 and 22 are restricted so as not to open any further.

The operation section 4 described later is provided with an arm section 21 and an arm section 22.
On the other hand, by operating to shift the arm 21 to the front side in FIG. 1, the engagement of the arm portion 21 with the hook 26 can be released. Thereby, as shown in FIG.
22 can be opened.

At the central portions of the arms 21 and 22, respectively,
Slits (guide thread fixing means) 212 and 222 are formed. The guide thread 20 described later is provided with the slit 21.
The guide thread 20 can be sandwiched and fixed by inserting the guide thread 20 into the second and the second threads 222.

An operation section 4 is provided on the base end side of the main body section 2. The operation portion 4 is configured by a ring-shaped finger insertion portion 41 fixed to the base end portion of the arm portion 21 and a ring-shaped finger insertion portion 42 fixed to the base end portion of the arm portion 22.

By inserting fingers (for example, thumb and index finger) into the finger insertion portions 41 and 42 and operating them like scissors, the arms 21 and 22 can be opened and closed.

It is preferable that the operation portion 4 is symmetrical (the front side and the back side in FIG. 1 are symmetrical). As a result, both a right-handed person and a left-handed person can use it.

A holding portion 3 for holding a plurality of (four in this embodiment) clips 10 is provided on the tip side of the main body portion 2. As will be described later, the clip 10 includes the everting portion 101 of the living blood vessel 100 and the end portion 20 of the artificial blood vessel 200.
It is to be joined (fixed) by sandwiching the overlapping portion with 1. The number of clips 10 that can be held by the holding portion 3 is not particularly limited, but is preferably about 2 to 20.

The holding portion 3 is composed of a plate-shaped holding plate 31 fixed to the tip of the arm 21 and a plate-shaped holding plate 32 fixed to the tip of the arm 22. Both holding plates 31,
32 are arranged to face each other.

The arm portions 21 and 22 are operated by the operation portion 4.
When the base end side of the (the base end side from the intersection 23) is opened, the arm 2
The front end sides of 1 and 22 (the front end side from the intersection portion 23) are also opened, whereby the holding plates 31 and 32 are separated (opened) from each other. On the contrary, when the proximal ends of the arms 21 and 22 are closed, the distal ends of the arms 21 and 22 are also closed, whereby the holding plates 31,
32 approach each other (close).

As will be described later, the clip 10 is attached to the holding portion 3.
While holding, the arm portion 21,
When 22 is closed, the holding plates 31 and 32 come close to each other, so that the clip 10 can be clamped and deformed. That is, in the present embodiment, the arms 21 and 22 (main body 2) serve as a transmission mechanism that transmits the operation of the operation unit 4 to the holding unit 3 and deforms the plurality of clips 10.

As shown in FIG. 2, a plurality of clips 10 are provided.
Respectively, in the vicinity of the tip of the holding portion 3, the holding plate 3
It is held so as to be sandwiched between 1 and the holding plate 32.

The clip 10 is substantially C-shaped,
In the state of being held by the holding portion 3, the deficient portion is directed toward the tip side and is in a posture substantially vertical to the holding plates 31 and 32.

The constituent material of the clip 10 is not particularly limited, but various metallic materials such as stainless steel, aluminum or aluminum alloy, titanium or titanium alloy, copper or copper alloy, and various non-metallic materials are used. You can

The clip 10 preferably has a property of being attracted to a magnet. This makes clip 1
If 0 is dropped in the surgical field, it can be easily and quickly recovered by bringing the magnet closer. To obtain the property of being attracted to a magnet, clip 1
As the constituent material of 0, for example, Fe-Si alloy, Fe
-Ni _{alloy, MO · Fe 2 O 3 (} M represents a metal element)
A magnetic material such as soft ferrite represented by is preferable.

The clip 10 may be coated with various biocompatible synthetic resin materials, various polymer materials, etc. in order to prevent corrosion and dissolution.

As shown in FIG. 4, on the inner surface side (upper surface side in FIG. 4) near the tip of the holding plate 31, there are provided recesses (grooves) 312 into which the lower end portion of the clip 10 in FIG. 4 can be inserted. 1
They are formed corresponding to 0, respectively. Similarly, on the inner surface side (lower surface side in FIG. 4) near the tip of the holding plate 32, a concave portion (groove) 322 into which the upper end portion of the clip 10 in FIG. 4 can be inserted.
Are formed corresponding to the respective clips 10.

As shown in FIG. 2, the tip portions 311 and 321 of the holding plates 31 and 32 are substantially arcuate, and the central portions thereof are recessed. Multiple clips 1
0 is arranged along the arc of the tip portions 311 and 321.

The plurality of clips 10 arranged along the arc in this way correspond to a substantially half circumference of the entire overlapping portion (anastomosis portion) of the everting portion 101 of the living blood vessel 100 and the end portion 201 of the artificial blood vessel 200. To do. That is, the tubular body anastomosis instrument 1
In A, the clip 10 is attached to approximately the half circumference of the anastomosis portion by one operation. The tubular body anastomosis instrument 1A of the present invention can be simplified in structure by mounting the clip 10 on approximately half the circumference of the anastomosis portion by one operation.

The radius of curvature of the arc in which a plurality of clips 10 are arranged in the holding portion 3 is not particularly limited, and is appropriately set according to the case such as the site of use and the application.

Particularly, the artificial blood vessel 2 is provided on the side surface of the living blood vessel 100.
When joining the end 201 of 00 (end-side anastomosis),
The radius of curvature of the arc in which the plurality of clips 10 are arranged in the holding portion 3 is preferably 1 to 50 mm, and 5 to 2
More preferably, it is 0 mm. The radius of curvature of this arc is the outer diameter (usually 2 to 6) of the target living blood vessel 100.
mm) or more) is preferable. As a result, the joint (anastomosis) can be formed into a substantially elliptical shape (see FIG. 9), and the artificial blood vessel 2 having a relatively large diameter with respect to the living blood vessel 100.
The end portion 201 of 00 can be easily joined.

As shown in FIG. 4, on the inner surface side of the holding plate 31, a spacer (projection) 104 as a deformation amount restricting means for restricting the deformation amount of the clip 10 is projected. When the holding plates 31 and 32 are brought close to each other to deform the clip 10, the holding plate 32 comes into contact with the upper surface of the spacer 104 in FIG. 4 to define the distance when the holding plates 31 and 32 come closest to each other. As a result, the amount of deformation of the clip 10 is restricted to a necessary and sufficient amount. Therefore, the amount of deformation is too small and the attached clip 10 falls off, or conversely,
It is possible to prevent the amount of deformation from being too large and the clip portion 10 of the living blood vessel 100 and the end portion 201 of the artificial blood vessel 200 from being too strongly pinched or penetrated by the clip 10.

As shown in FIG. 2, a plurality of guide threads into which the guide threads 20 for temporarily fixing the everting portion 101 of the living blood vessel 100 and the end portion 201 of the artificial blood vessel 200 can be inserted into the holding plates 31 and 32. Insertion grooves (slits) 313 and 323 are provided, respectively.

In this embodiment, the guide thread insertion groove 313,
323 are provided in three places on both sides and the center of the holding plates 31 and 32, respectively.
It is formed in a predetermined length from 1, 312 toward the base end direction. Also, the guide thread insertion grooves 313, 323 are
It is formed at a position avoiding the clip 10.

The pair of upper and lower guide thread insertion grooves 313 and 323 in FIG. 2 are formed at the same position, and one (one) guide thread 20 is inserted inside them. It is preferable that a plurality of the pair of guide thread insertion grooves 313 and 323 be provided (every two in the present embodiment) with respect to the clip 10.

The constituent material of each part of the tubular body anastomosis instrument 1A is not particularly limited, and for example, various metal materials such as stainless steel, aluminum or aluminum alloy, titanium or titanium alloy, nickel titanium alloy, and various hard resin materials. Etc. can be used.

The respective parts of the tubular body anastomosis instrument 1A of this embodiment are substantially symmetrical in the upper and lower parts in FIG. This allows it to be used upside down with respect to FIG.
It can be used without paying attention to the top and bottom.

Next, an example of how to use the tubular body anastomosis instrument 1A will be described in detail. [1] First, the arms 21, 22 of the tubular body anastomosis instrument 1A
The holding plates 31 and 32 are opened as shown in FIG. 3, and the clip 10 is set on the holding portion 3. At this time, the spring 25
Since the arm portions 21 and 22 are automatically opened by the urging force of the spring 25 when the hook 26 is disengaged from the arm portion 21, the operability is excellent.

When the clip 10 is inserted into each recess 312, the arms 21 and 22 are closed while the arm 21 is displaced relative to the arm 22 toward the front side in FIG. (See Figure 1). This allows
The holding portion 3 is in the state shown in FIG. 4, and both ends of the clip 10 are inserted into the recesses 312 and 322, respectively, so that the clip 10 is securely held. In this state, the arm 21
Is engaged with the hook 26 and the arms 21, 22 (holding plate 31,
Since 32) is prevented from opening, the clip 10 set on the holding portion 3 can be prevented from falling off.

[2] A case where the end portion 201 of the artificial blood vessel (tubular body) 200 is joined to the side surface (side portion) of the living blood vessel 100 will be described as an example. As shown in FIG. 5, the side surface of the living blood vessel 100 is incised to form an incision 102. This incision 1
The incision 102 is inverted (expanded) by turning over the edge of 02, and the inversion part 101 is formed at the edge of the incision 102.

The artificial blood vessel 200 has a straight tubular body 210.
2 having a flange-shaped end 201 at the end of the connector 2
20 is joined. That is, the artificial blood vessel 200
The end portion 201 of the (connector 220) is formed of a flange portion that projects outward over the entire circumference. Thereby, the anastomosis can be performed quickly and easily. In addition,
The artificial blood vessel 200 includes a body 210 and a flange-shaped end 2
01 may be integrally formed.

The guide yarn 20 is passed through each of the three portions of the outer turning portion 101 and the end portion 201. This guide thread 20
Is a clip 1 held by the holding portion 3 while temporarily fixing the portion where the everting portion 101 and the end portion 201 are overlapped.
It is used to position the overlapping portion on the inner side 110 of 0.

[3] As shown in FIG.
The tip portion of the holding portion 3 is applied to the overlapping portion of the end portion 201 and the end portion 201. At this time, the holding portion 3 is brought close to the overlapping portion of the everting portion 101 and the end portion 201 while pulling and tensioning the guide yarns 20 inserted in the guide yarn insertion grooves 313 and 323. As a result, the overlapping portion of the everting portion 101 and the end portion 201 is introduced (inserted) into the inner side 110 of the clip 10 by the guide thread 20, and the state shown in FIG. 4 is obtained.

[4] As shown in FIG. 7, each guide thread 2
With 0 being in a tensioned state, it is fixed by being sandwiched between the slits 212 and 222. As a result, the outward portion 101 and the end portion 20
It is possible to reliably maintain the positioning state (the state shown in FIG. 4) in which the overlapping portion with 1 is inserted into the inner side 110 of the clip 10.

When the operating portion 4 is operated to close the arms 21 and 22 from the state shown in FIG. 7, the clip 10 is clamped between the holding plates 31 and 32 and deformed. As a result, as shown in FIG. 8, the outer everting portion 101 and the end portion 201 have the clip 1
It is sandwiched by 0 and fixed (joined).

At this time, as described above, the spacer 31
Since 4 is provided, no delicate adjustment is required for the operation of closing the arms 21 and 22, and if the arms 21 and 22 are closed to the maximum (to the limit), the amount of deformation of the clip 10 is optimized. Become. Therefore, the operation is easy.

[5] After attaching the clip 10, the guide thread 20 is removed. As shown in FIG. 9, four clips 10 are attached by one operation, and almost half of the entire overlapped portion of the everting portion 101 and the end portion 201 is joined.

[6] In the same manner, the clip 10 is attached and joined also to a substantially half circumference on the opposite side (the back side in FIG. 9) in the overlapping portion of the everting portion 101 and the end portion 201. This completes the anastomosis.

Here, the case where the end portion of the artificial blood vessel 200 is joined to the side surface of the living blood vessel 100 (end-side anastomosis) has been described, but in the present invention, the living blood vessel 100 and the artificial blood vessel 2 are joined.
It is also possible to join the end portions with 00 (end-to-end anastomosis). Further, the living blood vessels 100 can be joined together.

<Second Embodiment> FIG. 10 is a perspective view showing a second embodiment of the tubular body anastomosis instrument of the present invention, and FIGS. 11 and 12 are plunger mechanisms in the tubular body anastomosis instrument shown in FIG. 10, respectively. FIG. 3 is a cross-sectional view of the installation part of FIG.

The second embodiment of the tubular body anastomosis instrument of the present invention will be described below with reference to these drawings. The description will focus on the differences from the above-mentioned embodiment, and the same matters will be explained. Omit it.

The holding portion 3 of the tubular body anastomosis instrument 1B of this embodiment can hold eight clips 10. As a result, eight (10 in total) clips 10 can be attached to a substantially half circumference of the overlapping portion of the everting portion 101 and the end portion 201.

Further, in this embodiment, the clip deformation amount adjusting screw 5 and the plunger mechanism 6 are provided.

The clip deformation amount adjusting screw 5 is attached to the clip 1
It serves as 0 deformation amount regulation means, and is screwed into the screw hole 213 formed in the arm portion 21 and installed so as to be substantially orthogonal to the arm portion 21.

The lower end 51 side of the clip deformation amount adjusting screw 5 in FIG. 10 projects toward the arm portion 22. Arm 2
When closing the clips 1 and 22 to deform the clip 10, the lower end 51 of the clip deformation amount adjusting screw 5 abuts on the arm portion 22,
Further closing of the arms 21, 22 is prohibited. Thereby, the amount of deformation of the clip 10 can be restricted to a necessary and sufficient amount.

Further, in this embodiment, the clip deformation amount adjusting screw 5 is rotated to adjust the protrusion amount on the lower end 51 side, so that the shape of the clip 10, the everting portion 101, and the end portion 2 are adjusted.
The amount of deformation of the clip 10 can be optimally adjusted according to the wall thickness of 01 and the like.

As shown in FIG. 11 and FIG. 12, the plunger mechanism 6 is provided on the arm portion 21 at the portion engaging with the hook 26, and has a rod-shaped nose pin 61 and a spring (coil spring) 62. ing.

The nose pin 61 is installed in a hole 214 formed in the arm portion 21 and is in a state of protruding from the hole 214 (a state shown in FIG. 11) and a state of being recessed in the hole 214 (shown in FIG. 12). The state) can be displaced.

The spring 62 is installed in a compressed state in the hole 214 and urges the nose pin 61 to project.

The upper end 611 of the nose pin 61 in FIGS. 11 and 12 is in contact with the hook 26. As a result, the plunger mechanism 6 biases the arm portion 21 toward the hook 26 downward in FIGS. 11 and 12.
That is, the plunger mechanism 6 urges the arms 21 and 22 to close.

As shown in FIG. 10, the clip 1 is attached to the holding portion 3.
When 0 is set, the plunger mechanism 6 is
The nose pin 61 has a hole 214
From the gap 21 between the arm 21 and the hook 26.
7 are formed.

In this state, the plunger mechanism 6 moves the arm 2
By biasing the holding plates 1 and 22 to close, the holding plates 31 and 32 are also biased to close, and the biasing force reliably holds (clamps) the clip 10. Therefore, in the present embodiment, the clip 1 set on the holding portion 3
It is possible to more reliably prevent the falling of 0.

When the clip 10 is set on the holding portion 3, a jig 30 as shown in FIG. 10 is used. The jig 30 is placed between the finger insertion portions 41 and 42 (or between the arm portions 21 and 22).
When it is bitten into
The gap 27 is slightly opened from the state shown in (1) (arrow X in FIG. 10). At this time, the nose pin 61 sinks into the hole 214 (state shown in FIG. 11).

In this way, when the jig 30 is bitten, the holding plates 31 and 32 are kept open to the extent that the clip 10 can be inserted, and the clip 10 is easily set on the holding portion 3. be able to. It should be noted that without using the jig 30, the clip 1 with the finger insertion parts 41 and 42 opened by hand
You may set 0.

Thus, in this embodiment, the clip 1
It is not necessary to release the engagement between the arm portion 21 and the hook 26 when setting 0, and the jigs 30 and the like are used to hold the holding plates 31, 3
The clip 10 can be set in a state where the clip 2 is opened, and the work of loading the clip 10 is easy. Further, at this time, since the arm portion 21 engages with the hook 26, the arm portions 21 and 22 do not open too much and are opened to the extent necessary and sufficient for loading the clip 10. Therefore, the work is extremely easy. .

When the clip 10 is loaded and the jig 30 is removed, the state shown in FIG. 10 is obtained, and as described above,
The urging force of the plunger mechanism 6 securely holds the clip 10.

When the clip 10 is deformed, the process shown in FIG.
From the state shown in FIG.
Is closed (arrow Y in FIG. 10).

Although the tubular body anastomosis instrument of the present invention has been described with reference to the illustrated embodiment, the present invention is not limited to this, and each part constituting the tubular body anastomosis instrument exhibits the same function. It can be replaced with any possible configuration.

For example, the holding portion is not limited to one in which the end portion (part) of the clip is inserted into the concave portion and held, and for example,
Something like holding a clip by attracting it with magnetic force,
It may also be one that is attached and held by an adhesive.

Further, the transmission mechanism for transmitting the operation of the operation portion to the holding portion to clamp and deform the clip is not limited to the illustrated construction, and any mechanism such as a link mechanism or a cam mechanism may be used. Good.

Further, in the present invention, the holding portion for holding the plurality of clips may be detachable from the instrument body. By this, by exchanging the holding part in which the clip is set in advance, repeated use can be performed quickly and easily.

Further, the clip is not limited to the one having a substantially C shape, and may be, for example, one having a substantially U shape or a substantially L shape.

[0082]

As described above, according to the present invention, a plurality of clips can be easily and surely attached to the overlapping portion of the end portion of the tubular body and the inversion portion of the blood vessel with a simple structure. it can. Therefore, an anastomosis (joining) between the tubular body and the blood vessel with a plurality of clips can be performed quickly and reliably.

Particularly, when the transmission mechanism for transmitting the operation of the operation portion to the holding portion to clamp and deform the clip has a pair of rotatably connected arm portions, it is extremely simple. With the structure, the above effect can be achieved.

Further, when the arm restricting means for restricting the front ends of both arms from being opened is provided, it is possible to easily and surely maintain the state in which the clip is held in the holding part, and to improve the operability. Excel.

Further, when the deformation amount regulation means for regulating the deformation amount of the clip is provided, an appropriate deformation amount of the clip can be obtained, and safety and operability are high.

[Brief description of drawings]

FIG. 1 is a perspective view showing an embodiment of a tubular body anastomosis instrument of the present invention.

FIG. 2 is an enlarged perspective view showing a distal end portion of the tubular body anastomosis instrument shown in FIG.

FIG. 3 is a perspective view of the tubular body anastomosis instrument shown in FIG. 1 (with both arms open).

4 is a cross-sectional view of a holding portion in the tubular body anastomosis instrument shown in FIG.

5A to 5C are views for sequentially explaining a method of using the tubular body anastomotic device shown in FIG.

FIG. 6 is a diagram for sequentially explaining a method of using the tubular body anastomosis instrument shown in FIG.

FIG. 7 is a diagram for sequentially explaining a method of using the tubular body anastomotic instrument shown in FIG.

FIG. 8 is a cross-sectional view of an anastomosis portion.

FIG. 9 is a perspective view of an anastomosis unit.

FIG. 10 is a perspective view showing a second embodiment of the tubular body anastomosis instrument of the present invention.

11 is a cross-sectional view of an installation portion of a plunger mechanism in the tubular body anastomosis instrument shown in FIG.

12 is a cross-sectional view of an installation portion of a plunger mechanism in the tubular body anastomotic instrument shown in FIG.

[Explanation of symbols]

1A, 1B tubular body anastomosis device 2 body 21 and 22 arms 211,221 long holes 212, 222 slits 213 screw holes 214 holes 23 intersection 24 pin 25 spring 26 hooks 27 Gap 3 holding part 31, 32 holding plate 311, 321 Tip 312, 322 recess 313, 323 Guide thread insertion groove 314 Spacer 4 operation part 41, 42 finger insertion part 5 Clip deformation adjustment screw 51 bottom 6 Plunger mechanism 61 nose pin 611 upper edge 62 spring 10 clips 110 inside 20 guide thread 30 jigs 100 living blood vessels 101 Abduction Department 102 incision 200 artificial blood vessels 201 Edge 210 main body 220 connector

Claims (9)

[Claims] 1. A plurality of clips are attached to an overlapping portion in which an end portion of a tubular body and an everting portion of a blood vessel are overlapped with each other,
A tubular body anastomosis instrument for joining an end portion of the tubular body and an everting portion of the blood vessel, which holds a plurality of the clips in a state of being arranged so as to correspond to substantially a half circumference of the entire overlapping portion. A holding unit, an operation unit that performs an operation of deforming the plurality of clips, and a transmission mechanism that transmits an operation of the operation unit to the holding unit to hold and deform the plurality of clips. The overlapping portion is inserted into the inside of the plurality of clips held by the portion, the plurality of clips are deformed by the operation of the operation portion, and the end portion of the tubular body and the everting portion of the blood vessel. A tubular body anastomotic device characterized by sandwiching and joining. 2. The tubular body anastomosis instrument according to claim 1, wherein the holding portion holds the plurality of clips so as to be arranged along an arc. 3. The tubular body anastomosis instrument according to claim 2, wherein the radius of curvature of the arc is 1 to 50 mm. 4. The transmission mechanism has a pair of arm portions rotatably connected to each other at a middle portion or an end portion thereof, and the operation portion is provided at a proximal end side of the both arm portions and a distal end side thereof. Holding parts are respectively provided, and by operating the operation part so that the proximal ends of the both arm parts are closed, the distal ends of the both arm parts are closed to deform the plurality of clips. 4. The tubular body anastomosis instrument according to any one of 3 to 3. 5. The tubular body anastomosis instrument according to claim 4, further comprising arm restricting means for restricting the front ends of the both arms from opening beyond a certain limit. 6. The tubular body anastomosis instrument according to claim 1, further comprising a deformation amount regulation means for regulating a deformation amount of the clip. 7. Formed at a plurality of locations near the holding portion,
2. A guide thread insertion groove into which a guide thread can be inserted.
7. The tubular body anastomosis instrument according to any one of 1 to 6. 8. The tubular body anastomosis instrument according to claim 1, wherein the clip is substantially C-shaped. 9. The tubular body anastomosis instrument according to claim 1, wherein the holding portion has a recess into which a part of the clip can be inserted.